An estimated 3.3 million Americans will live in the nation's nearly 16,000 nursing homes during 2013. That number translates to 1 in 7 people ages 65 and up, and more than 1 in 5 of those 85 and older. They and their families will want and need a way to find a source of the best possible care. For many, it won't be easy.
To help them, U.S. News has collected meaningful data and ratings about nearly every nursing facility in the United States, and built from them a searchable database designed to highlight the highest-rated homes likely to meet each user's needs.
The data behind Best Nursing Homes come from Nursing Home Compare, a website run by the federal Centers for Medicare & Medicaid Services. CMS sets and enforces standards for nursing homes enrolled in Medicare or Medicaid, as most are. The agency also collects information from states and individual homes and assigns each home (other than a few too new to have built up enough months of data) a rating of one to five stars in each of three categories: state-conducted health inspections, nursing and physical therapy staffing, and quality of medical care. The ratings are combined to produce an overall rating of one to five stars.
CMS does not regulate retirement or assisted-living communities, since their cost is not covered by Medicare or Medicaid, and U.S. News does not evaluate them or include them in the Best Nursing Homes database.
U.S. News built Best Nursing Homes 2013 using data published by CMS in January 2013. Homes in all 50 states and Washington, D.C., are included. By default, homes within a given state or city are grouped into tiers by overall star rating—all five-star homes, all four-star homes, and so on. Homes that did not receive an overall rating from CMS in January appear below one-star homes. Within each tier, homes are listed alphabetically.
In January 2013, 3,036 nursing homes earned an overall rating of five stars from the federal government. Their profiles on usnews.com display a badge in recognition of this status. U.S. News will periodically update its ratings and other data during 2013 as new data become available from CMS, but only those homes recognized in January will display a badge throughout the year.
Here are the details of the elements that determine each home's star ratings:
Health inspections. Because almost all nursing homes accept Medicare or Medicaid residents, they are regulated by the federal government as well as by the states in which they operate. State survey teams conduct health inspections on behalf of CMS about every 12 to 15 months. They also investigate health-related complaints from residents, their families, and other members of the public. "Health" is broadly defined. Besides such matters as safety of food preparation and adequacy of infection control, the list covers such issues as medication management, residents' rights and quality of life, and proper skin care. A home's rating is based on the number of deficiencies and their seriousness and scope, meaning relatively how many residents were or could have been affected. Deficiencies are included if they were identified during the three latest health inspections and in investigations of public complaints in that time frame. State inspectors also check for compliance with fire safety rules, although their findings are not factored into the CMS ratings. Best Nursing Homes displays the full range of health and fire inspection results online.
Nurse staffing. CMS determines the amount of time per day patients receive from the nursing staff, because even first-rate nurses and nurse aides can't deliver quality care if there aren't enough of them. Homes report the average number of registered nurses, licensed practical nurses, licensed vocational nurses, and certified nurse aides and assistants on the payroll during the two-week period before the latest health inspection. The number of hours they worked is also reported. Agency temporary employees do not not count toward a home's totals. That information is compared with the average number of residents during the same period and crunched to determine the average number of daily minutes of nursing time. To receive five stars in the latest CMS ratings, the nursing staff had to provide nearly 4½ hours of care a day to each resident, including about 43 minutes from registered nurses. The time for each home is shown in the ratings. Last year CMS also began displaying the number of hours residents receive from physical therapists.
Quality measures. CMS requires nursing homes to submit clinical data for the latest three calendar quarters detailing the status of each individual Medicare and Medicaid resident in 18 indicators, such as the percentage of residents who had urinary tract infections or who were physically restrained to keep from falling from a bed or a chair. Best Nursing Homes, like Nursing Home Compare, displays all 18 data points for each home. The ratings, however, are based on nine—seven for long-term and two for short-term residents—that are considered the most valid and reliable, such as the two above and other measures related to pain, bedsores, and mobility.
Good ratings or bad, CMS is adamant in cautioning that they are just a starting point. We agree. Nothing substitutes for in-depth visits. You can ask questions, observe residents and their families and caregivers, and get a feel of a home that stars can't communicate. "There are many satisfied residents and families of residents in nursing homes...at the one-star level," states an FAQ posted on the CMS website, which also advises that "no resident should be moved solely on the basis of a nursing home's ratings.... [Transferring] your loved one to a facility that has a higher rating should be balanced with the possible challenges of adjusting to a new nursing home." That is one of many hard truths about finding a home where someone you hold dear can find good care.
[Read How to Choose a Nursing Home.]